Motivate the other team members, demonstrating an optimistic attitude, despite of the unsuccessful dental procedure from time to time (patient’s mood, lack of cooperation, etc.). Next time a patient (phobic, anxious) may cooperate much better !

Learn from failings ! Inhalation sedation or even intravenous sedation with midazolam can be unpredictable as individual reaction to above mentioned sedatives.

Triage the patients, if significant number referred to service.

Simple things make a difference ! bring through the patient from a waiting room, shake patient’s hand ‘to break the ice’ , use  a preferred  name/middle name/nickname, and after all keep smiling !

Body language and tone of voice vitally important ! Patients, particularly elderly and with poor medical health condition do not focus on information provided

If patient has got a very slow speech, may take him/her a long time to answer. Do not assume that patient cannot respond if there is no immediate answer!

Forget about the ‘professional jargon’ with plenty of ‘wise words’, patients expect just a normal and sincere conversation, professional and empathetic approach and nothing else.

Keep instruments and other dental equipment behind the patient, particularly do not show any dental tray

If the anxious patient is not in pain, it is ‘sensible’ to start from the easiest procedure to build up the patient confidence and trust.

Occasionally, especially for ‘first time’ or patients with severe disabilities patients  it is vitally important to ‘lower the level’ of communication, eg. to kneel down by anxious paediatric special needs patients. It reduce the distance and creates more direct contact between patient and dentist.

Dentist sitting on dental chair while paediatric/special needs patient sitting on normal chair can be very good approach for some of the patients in order to ‘break’ the barier and distance.

Keep treatment plan as simple as you can

The main goal is to secure oral health generally. Avoid ‘overtreatment’ if there are no strict indications for it (eg. extractions of asymptomatic deciduous teeth in the late stage of exoliation)

Do not delay referal to get dental treatment completed under sedation. Behavioral management or CBT not always successful

If patient with special needs cannot tolerate blood sample collection, it will not be a good candidate for IV sedation (cannulation) without extra measures, eg. oral pre-med, intranasal

 

In some ‘challenging’ patients, particularly children,  so-called ‘caries stabilization’ with initial caries removal and cariostatic GIC use is better option than definite treatment ‘in one go’.

Realistic approach and pragmatic treatment plan is better than too sophisticated and extended dental care, with unpredictable final results.

Working day organisation and planning should be precise. For instance – the most challenging clinical cases can be allocated at the end of the day.

Task delegation is essential, including other dental team members in the whole treatment process (dental hygienist, therapist, clinical lab technician).

Routine check list for all sedation procedures and techniques.

Oral (pre)sedation using bitter midazolam solution can be better accepted by patient if mixed with eg. concentrated lemon juice.

Good practice to ask patient whether is on oxygen, particularly elderly and medically compromised patients. Lots of patients do not disclose this information on medical questionnaire! If any signs of oxygen desaturation – deliver immediately oxygen via face mask alternatively nasal cannula. This is especially important for elderly patients.

Letter to referred GDP, GP, etc. re: the completed treatment achieved, results, further proceeding, outcome of treatment, prognosis, etc. is always recommended as a good practice protocol.

Carers/relatives are invaluable source of clinical information regarding persons living in residential nursing home.

There is a small chance for successful denture work in uncooperative elderly patients, particularly with late stage of dementia/Alzheimer’s disease.

Copy denture technique should be considered for elderly patients

Patient with Guillain-Barré syndrome, a rare and serious condition of the peripheral nervous system, may be at an increased risk of side effects caused by local anaesthetic agents. LA in some cases can be contraindicated or can be administered only in a hospital setting.

General Anaesthesia

Meeting with a team before, eg. GA session including discussion about any problems related to the treated patients: obesity, medications, adverse reactions to GA in the past, respiratory problems, escorts problems, social background, etc.

Scale first and then recheck charting as some cavities may not be initially visible/detectable

Concentrate on one side or one quadrant while completing tx plan

Start exodontia under GA from the lower arch, and then upper one. This allows better operational field control (bleeding control).

Laryngeal mask quite often just enough for straightforward procedures under GA, instead of full intubation. Disadvantage: risk of dislodgment, risk of hypoxia/anoxia, not ideal air ways management.

 

Intravenous sedation

Cannulation for IV sedation: how to find the dorsal vein ? tricks: gravity – put the hand down, apply heat pack, tap the hand, pressure on the arm with fingers or glove.

Pulse oximeter finger scanner may interfere with (false readings): nail varnish, false varnish, strong direct light, CO2 in the air, shaking body, hands, fingers tapping.

For IV sedation patient should be qualified using ASA scale, ideally full cardio-monitoring (O2 saturation, HB, RR, pulse, and ECG) should be used (portable equipment) to monitor vital signs during IV session.

The common problem during IV sedation: apnoea, not midazolam overdose !. Action: shake the patient, request – “deep breath please” !, oxygen administration with nasal cannula or face mask, just turn it on, oxygen cannot be be overdosed.

If not the right vein – leave cannula in place and put another one nearby – no blood, can be removed later on.

For IHS sedation: first – turn the oxygen on, then put the mask, with a gentle pressure to seal it.

‘Thermal’ hydrogel in the form of eg. head rest/cushion for a dental chair makes the (prolonged) dental treatment much more comfortable and tolerable, particularly for patients with neck and shoulders problems, muscles spasms, etc.

 

Inhalation sedation

Calm music has a synergistic effect with N2O/O2 sedation.

Aromatherapy, eg. using ‘car refresheners’ in dental surgery or special silicone flavoured bands placed in nasal hood during IS may support the effect of N20/O2

There is enough room for VR googles while holding a nasal hood and applying IS

Oxygen use in case of any signs of hypoxia during any sedation procedure and do not hesitate to firmly ask the patient: “Take a deep breath Mr/Ms….please” !

There is a possibility of use of adapted nasal cannula for N2O/O2 delivery instead of nasal mask during the restorative treatment of eg. upper incisors.

ClearView masks or Siluetthe masks can be better tolerated by some patients

Inhalation sedation may reduce severe gag reflex

 

Prevention

Topical fluoride varnish 22600ppm seems to  be very efficient desinsitising agent easing dentin hypersensitivity (exposed roots, exposed cervical areas, cervical abrasions, etc).

High concentrated Duraphat TP 2800ppm or 5000pm is an efficient desinsitizing agent

Multiple fissure sealants on posterior teeth, including premolars, also on any grooves within upper teeth (eg. palatal anatomical pit on lateral incisors), especially if there is an increased caries risk in patient unable to carry out routine oral hygiene regime (patient with special needs).

Simplified fissures sealing procedure with GIC material (eg. Fuji Triage) in case of difficult moisture control and non compliant patiene (special needs)

F/S rather than invasive treatment if possible

FUSION light for caries diagnosis and oral cancer screening

 

Restorative Dentistry

Sonic tips with abrasive coating may be very useful for initial cavity opening or even full cavity preparation in children. Less stressful, no noise, young patient are usually very happy with this approach !. Can be used as an initial stage during familiarization or for so called: ‘caries control and suppression’.

Use more often ‘increased speed handpiece’ (with the red strip) instead of turbine esp. for phobic patients who do not tolerate fast hp noise ! (micromotor is much quiet compared to turbine)

Use ‘turbine with water off’ option (usually button on pedal, eg. yellow by Belmont unit) for teeth during during eg. fillings, instead of 3-in-1 syringe. Some patients can be pretty quite scarred  seeing ‘a new piece of equipment’. It  does saves the time and limits an operator’s body movements/turnings. Also great option from ergonomic point of view.

self-etch bonding system and bulk fill composite allow a quick restoration and are less time consuming which can be essential providing treatment for less co-operative patients, children and special needs persons

FUSION special light with ultra fast 3 sec cures very useful for young patient with short attention span or disable patients

Step-wise restorative technique or so-called “therapeutic sealants” can be in selected cases suitable in patients with special needs

The use of ready-to-use temporary ProtempCrown may simplify the crown/bridges procedures and shorten the working time

If the disable patient with speech impairment is unable to indicate his/her dental problems, sometimes ‘tooth slooth’ (diagnostic bite stick or orthodontic band/crown placer ) may help to establish a proper clinical diagnosis. Used to assess the cracked teeth and/or incomplete cusp fracture. By facial expressions dentist can suspect the causative tooth.

 

Prosthodontics

Copy denture technique when possible for elderly patients

The use of special silicone material for bite registration (short setting time, durable) particularly during dom visit

The use of ready-to-be used alginate-substitute material (no need for mixing)

Medium body wash VPS silicone for functional impressions

Protemp Crown temporary solution for fixed prostodontics temporization (easy, quick and long lasting)

 

Oral surgery

For medically compromised patients with risk of adrenaline interference, it is safer to use articaine with adrenaline 1:200000 than lidocaine with adrenaline 1:8000.

If the 2% lidocaine LA IANB (inferior dental block) failed, it is more effective to use a second LA ID block injection with a different amide-type LA with higher % eg. 3% prilocaine. It does work better than 2x lidocaine dose.

Ultra-short needle for infiltration LA very handy in case of eg. restless, agitated patient, patient with involuntary movement, tremor, etc. Much better control of injection precision compared to standard lenght 30G, less risk of needle stick injury.

Deeply buried and grossly decayed retained roots of molar deciduous teeth, difficult to extract using elevator or forceps,  can be easily removed using eg. pointy Steiglitz forceps or ‘Mosquito’ forceps (ideally angled)

Square gauze can secure eg. extraction of tiny parts of deciduous upper teeth and prevent from accidental tooth aspiration/swallowing.

The use of press pack with chlorhexidine gel 1% or wash following extraction may prevent post-xla complications, particularly after surgical removal of third molars.

Even single sutures’ make patient more comfortable after xla (psychological effect), what is more, make patients’ carers feel more (dentist demonstrates caring attitude).

Standard swab to apply topical measures within oral cavity

Simple diagnostic test utilizing local anaesthesia can help to figure out the causative tooth if the patient cannot indicate specifically the origin of odontogenic pain, eg. non-verbal following stroke episode.

Efficient and recommended surgical bur –  Oral Surgery Tapered Fissue 702 171.011.016 (Dentsply) for surgical extractions, esp. roots separation

Piezo surgical technique is efficient and less traumatic for dealing with impacted third molars.

PDL luxators can be very helpful for simple semi-surgical exodontia

Slight ‘semi-rotation’ tooth luxation allows more efficient tooth loosening from the socket.

Always advisable to carry out a post-extration ‘sinus -test’ following removal of upper molar tooth

If oro-antral ‘sinus’ communication test is positive, but seems to be pretty small, to consider ‘natural healing approach’ without flap rising and flap respositioning. Just haemostatic agent packed inside the socket, ideally resorbable membrane one the top and few simple sutures. Is is particularly useful for ‘challanging’ patient who may not cope with standard flap procedure.

In this case: preferably, if available, it is good idea to use so called ‘liquid bandage’ ie. adhesive oral agent on the top of the alveolar socket and sutures.

The ends of non-resorbable sutures should not be too short (1-2 mm are too short) and need to be slightly elongated up to 3-4 mm. Reason: better adaptation to oral mucosa (eg. buccal), better tolerance by patient (too short are ‘spiky’, like the very short hair), less risk of loosening.

Hydrogel cold pack after multiple xla(s)/xga(s) or surgical extractions can be very helpful to diminish post-operative swelling and discomfort. Advice for patient to keep it for 30 mints in the fridge before using externally , to apply on cheek. Also, it can be used to ease facial muscles tension/spasm during dental procedure as a ‘warm version’ following keeping hydrogel pad in a hot water (not in microwave !)

Single use cold pack

Apart from antibiotic Px following surgical xla, it is recommended to add NSAID (Ibuprofen), Calcium suplement and vit . B12 tablets.

Ultra soft toothbrush with increased number of filaments (0.1 mm diameter, > 5000) advised post-operatively, eg. after multiple xla(s) or xga(s) may help the patient to tackle the post-operative discomfort.

Patient with special needs may tolerate quite well a surgical extraction of eg. buried root. Decision must be taken individually and sedation (oral, IHS, IV) may definitely ease the procedure.

Considering the extraction of partially impacted third molars, with at least 1/2 coronal portion visible intraorally and favourable position, in some cases procedure can be carried out making only one retromolar incision. This allows to avoid to extensive flap rise and prolonged post-operative healing, particularly in disable patients, with learning disability.

For a wide open socket(s) followig extraction, ‘cross’ (duble) mattress suture can be very helpful allowing an easy adaptation of surrounding mucosa and facilitating post-op healing. It works very well also for multiple extractions, eg. two or more incisors incisors, premolars, molars.

In case of buccally displaced, partially impacted upper third molar, with distal angulation in patient with horizontal alveolar bone loss, there is a high risk of occurrence of oro-antral communication as complication following even simple extraction. Incision more by palatal site (actually almost on the top of alveolar ridge, instead of buccaly may allow a better flap adaptation. Mattress suture required if communication occurs, after haemostatic agent (sponge) placement which is also acting as ‘mechanical barrier’ along with blood clot.

Floppy, hyperplastic denture-induced alveolar ridge oral mucosa can be easily re-countoured using surgical scissors for excision. Mainly by buccal portion as the most prominent mucosa overgrowth, to try not to perform any surgical intervention by palatal site and on the top of alveolar ridge. Incisal papilla has to preserved, only minor/mild recontouring advisable, if indicated. It is a good practice to place a haemostatic sponge (ideally as a flat version of ‘tape’) on fitting surface of pt’s denture. Patient is advised to wear the denture till the rest of the day (or up to 24 hours) after procedure.

Distoangulated and impacted lower third molar is often more difficult to extract compared to third molar presenting mesioinclination. Oblique, mesial crown sectioning (surgical) along with alveolar bone removal by distal portion (mandible ramus margin) often necessary to allow successful extraction. Lindemann bur for straight hand-piece very useful but it has to be used ‘wisely’ as round bur ‘safer’ in terms of surrounding anatomical structures.

Clinical and radiological criteria for “most challenging” lower third molars extractions: middle age (compacted bone structure), disto-lingual angulation/inclination, dense mandubular ramus bone structure, close proximity towards inferior alveolar canal, ankylosis, anatomical variations.

Clinical and radiological criteria for “relatively easy” lower third molars extractions: young age up to 18 y.o. (short roots which may be not fully developed, susceptible bone structure, vertical position or slight mesioangulation, with at least 3/4 occlusal surface visible, close to occlusal plane (near second molar occlusal surface level), distal radiolucency (bone resorption due to granulomatous tissue, less bone suport, easier to luxate.

In case of fully, horizontally impacted lower third molar, it is always wise to anticipate an extremely difficult surgical extraction. Referral to oral or maxillo-facial unit recommended, particularly in case of distoangulated and impacted third molars.

During surgical extraction or surgical root retrieval:

• minimize number of incisions,
• avoid vertical incisions,
• safe as much bone as possible.

Buccal/Lingual hook retracting the full muco-periosteal flap. Not to press too hard, gentle operation to avoid soft tissues trauma.

Remember about additional accessory innervation within mandible which may affect the efficiency of IANB. Additional retromolar branches of long buccal nerve, lingual nerve and mylohyoid nerve.

Are there any indications for extraction of partially erupted and hardly symptomatic third molars in teenagers due to orthodontic reason? (carried out under LA, IS, IV sedation or GA).

Less extended and less traumatic envelope flap can be applied for vast majority of lower partially erupted teeth removal

Be careful re: lingual nerve location, which is mostly very close to lingual/internal margin of mandible ramus and alveolar ridge. Can be traumatize easily if not enough caution while flat rising.

Be careful re: surgical removal fully impacted upper third molars, especially if distoangulated. Risk: maxillary tuberosity fracture/dislodgement and displacement of tooth to anatomical space distally.

Are balanced extractions of all undeveloped third molars at the age eg. 15 years justified from orthodontic point of view? (ortho referral from specialist orthodontist, consultant)

 

It is a good dental practice to place a suture (even just a single) following even simple molar xla as often as possible for special needs patients. Apart from promoting wound healing this has a positive ‘psychological effect towards patient’s well being and post-op comfort.

Incision biopsy, punch biopsy or just total incision of benign-looking oral mucosa lesion in primary care helps to safe a travel to nearest specialist service which can be a far away, particularly within a rural areas. Some patient, eg. bariatric, with social phobia, severely medically compromised, bed bound, etc cannot travel to secondary care unit, usually high-reference hospital. Stay in touch with a local nearest oral surgery unit and ask about the optimal protocol to look after a patient with suspected lesion.

 

Additional tools (camera, chair-side test) for detection of oral mucosa lesions may support proper diagnosis and avoid unjustified referral for secondary care, but as the sensitivity and specificity are not as high (not 100% reliable), they  should not replace biopsy and HP check.

Do not attempt to place ‘too tight’ sutures after surgical xla/xga of third molar(s) It must be  a natural drainage and exudation evacuation.

Vertical, interdental mattress sutures (between eg. first and second molar very useful after procedure with the envelope  flap rise for surgical third molar extraction.

Haemostatic sponge plus horizontal, cross mattress sutures can be applied in case of suspicion of oro-anto communication, eg. doubtful ‘blow out’ test, to avoid a full flap repositioning.

Be cereful re: sectioning upper molar tooth for roots separation, better to separate using not as a horizontal anterior-posterior cut in the middle of the crown but slightly semi-lunar cut to separate palatal portion from buccal one. Always consider checking if there is post-xla the oro-anto communication as too deep cut may result in maxillary sinus opening.

Good practice ‘tip’ following difficult surgical extraction with flap rise eg.  lower third molar(s): to squeeze the soft surrounding tissues (alveolar mucosa) in order to evacuate the submucosal blood excess,  advise the patient to practice mouth opening and not to restrict mandible movements during post-operative period (patients often tend to limit mouth opening avoiding pain/discomfort).

Good practice ‘tip’ following surgical extraction with full flap rise: to flush, to irrigate operational field, especially area of exposed alveolar bone and periosteal ttissue with copius amount of 0.9% saline solution. It prevents from prolonged healing proces caused by small remnants of cutted/trimmed bone. They are removed during irrigation.

Lingual franectomy (lingual frenulum) can be safely performed using surgical scissors instead of scalpel. Lingual and labial franectomy (labial frenulum) shoud be well clinically justified, however delay in decision re: timing may have a negative impact on function and appearance (diastema).

After extraction, if the patient is unable to follow the post-operative instruction (reluctant to bite down), it may be good idea to use a ‘rubber’ mouth prop on the top of gauze, which can be firmly pressed for a while, necessary to arrest the post-operative bleeding.

If patient is unable to follow post-extraction advice regarding application of cold pack (due to eg. physical disability), in case of fairly invasive procedure like (semi)surgical tooth removal, it is worth to gently advise to eat some really cold and semi-solid food, eg. sorbets or to  eat eg. crushed ice cubes.

The use of haemostatic sponge soaked with steroid (eg. dexamethasone) may be efficient for post-operative discomfort control.

If patient cannot tolerate sutures after extraction(s), it is worth considering so-called tissue-adhesives, based on cyanoacrylates, used in oral surgery.

Partially erupted lower third molar, occasionaly symptomatic. DPT reviewed: proper direction of eruption, no angulation, likely to have single root (fused roots ?), straight, not curved, distal radiolucency behind coronal portion due to residual fillicular (dentigerous) cyst.

Degree of procedural complexity – mild. Semi-surgical XLA, small distal incision behind distal apsect up to 1 cm, no vertical incisions necessary. Gentle full flap rise (partially). Quick and uneventful XLA with elevator and forceps. Thorough socket debridement, removal of follicle residue with surgical ‘spoon’ (needle holder seems to be more handy to grasp and hold the follicle rests. Two  standard sutures. Post-operative instructions.

Thorough socket post-xla mechanical debridement may prevent from excessive post-operative bleeding (removal of granulomatous tissues and remnants).

Simple operculectomy in case of recurrent pericoronitis, third molar in favourable position

Periofilm – an adhesive antiseptic dressing – can be very helpful for post-xla healing control.

Passive fistula on alveolar mucosa labially, irregular bright (radiopaque) dots/spots within alveolar socket after tooth extraction (sometimes many years ago) present on intraoral periapical radiograph may suggest the remnants of dental filling or root canal material which has been left during, eg.  surgical xla with tooth sectioning and removal of roots fragments.

When OPG or PA radiograph displays ‘a bit ambiguidies’ morphology of third molar, always anticipate a difficult extraction: Case: mesial ‘root(s)’ unproportionally larger than distal, doubled, blurred contours of mesial root(s). Initial diagnosis: dilacerated mesial root, post-operative diagnosis: three-rooted third molar, with extra lingual root present (small and thin), curved and superimposed by buccal root:

 

 

 

 

 

Paediatric dentistry

Always Tell-Show-Do approach, but firstly demonstrate eg. hanpiece on own finger/nail, than on child’s finger nail

The most essential is calmless ‘sensibility’ of dentist

Cartoon “Once Upon a Time” (Fr.) about teeth brilliant for children before dental appointment !

The ultra fine and ultra short needles for children and for intraligamentary anaesthesia

The use of Wand for  LA may minimise LA fear

Intrapapillary LA with articaine works very well for any tooth!

Do not overdose LA in children and always give post-operative precautions – lips can be deeplyulcerated due to habitual biting after LA.

Self-etch bonding system instead  of traditional etch/rinse and bond to avoid unlpeasant ‘acidic’ taste

Colorfull flowable composite may work better and longer than even resin modified GIC (evidence based data).

Low diameter suction tip instead of a standard wide one

Lips retractor can be very helpful during restorative or OH procedures within an anterior region

Small sectional matrices (bands) instead of standard type better tolerated by children

Sonic scaler and ‘air abrasion preparation’ better tolerated than ‘drill’ !

Soak avulsed tooth in tetracycline sulution – it may prevent from replacement resorption following tooth replantation.

While making an ortho referral for fixed prosthodontics inform the parents re: potential complications, eg. external root resorption

For vital amputation is better to use MTA, not calcium hydroxide, more predictable clinical outcome

Sharp excavator is irreplaceable for vital pulp amputation in deciduous teeth, it may prevent from accidental pulp floor perforation

Special excavator made of vanad element excellent for carious dentin removal (ART technique) – durable, efficient

Aways radiograph before vital amputation in baby tooth! VA contraindicated of signs of natural root(s) resorption.

Distractive syringe ‘sleeves’ – “crocodile-looking” for children dental patients diminishing of anxiety caused by syringe fear during local anaesthesia

 

Techniques and practical modalities helpful for management of dental patient, also with special needs:

• short masticatory muscles relaxation before prolonged dental procedure, particularly difficult molar tooth extraction or restoration in case of muscles hypertension and TMJ problems
• the use of adhesive onlays or composite endo-restoration following RCT in molar tooth instead of time consuming core build up and then crown coverage, more comfortable as reasonably quick and predictable outcome

Prosthodontics

Cr-Co denture instead of acrylic one in patient who has difficulty with denture hygiene due to eg. physical disability

The best restorative treatment outcome for patient with poorly controlled/uncontrolled epilepsy and frequent grand mal fits who lost upper central incisor. Due to the high risk of bridge detachment and aspiration/inhalation or acrylic denture fracture during seizures, optimal outcome would be Cr-Co denture with additional anchorages to prevent from dislodgement.

The use of silicone putty impression material instead of alginate to allow airway protection

Denture can be easily removed by patient with physical disability and compromised manual dexterity if buccal flange has a horizontal groove made on purpose using a bur.

Fixative “cushions” can be better tolerated than fixative gel  or powder

Fixative powder was reported to be more efficient than gel form

 

 

Endodontics, Root canal treatment

RCT on molar tooth under IV in phobic patient can be a true challange. Vast majority of sedationists feel not comfortable providing this type of dental procedurę under IV.

Rotary Ni-Ti endo files and cordless endomotor are handy for RCT in special needs patients. Less risk of instrument dislodgement compared to finger instruments. Quicker root canal preparation.

(Ultra)sonic tips (coated or not) for USS, also using so called ‘endo-chuck’ very useful for orifices searching and irrigants (sodium hypochlorite) activation. They allow better irrigant penetration into apical portion of root canal.

The use of an electric gutta-percha cutter instead of heated  ball burnisher or excavator appears to be more comfortable for phobic dental patients

MTA or Biodentine biocompatible materials are first choice materials for eg. ‘micro’ pulp exposure in order to maintain the vitality of the (im)mature tooth and they significantly reduce the chance of RCT, which is particularly important in special needs patients.

Biodentine first choice lining and ‘regenerating’ material in deep carious cavities with the risk of pulp exposure during preparaiton. Even as long-term dressing to monitor tooth response.

After complicated RCT carried out in ‘sensitive’ patient with ‘low pain threshold level’ always tell the patient: “it is going to be painful afterwards for the next up to 24 hours, but should get gradually better”. NSAID Ibuprofen 400mg recommended, initially double dose 400mg to diminish post-procedural inflammatory reactions.

Standard precaution following root canal treatment: Ibuprofen 400mg regime, minimum TDS/3 days plus cytoprotective medication (eg. omeprazole if increaed risk of stomach problems).

 

Miscellaneous

The gentle use of lead apron in order to calm down the anxious patient

Wireless intraoral camera seems to be a perfect measure to collect evidences during general dental examination, during domiciliary care and GA session and can act as a source of objective evidences, recorded also for administrative purpose.

Flexible ‘fiberoscope-like’ intraoral camera can be extremelly useful during performing of dental assessment for the patient reluctant to mouth opening, with trismus, muscles spasms, etc.

In case of initial (minimal) cavity/cavities observed on BW radiographs, with only part of enamel involvement (small ‘wedge-like’ radiolucency close to contact points interproximally), minimally invasive approach is recommended, including separation with eg. ortho band, gentle stripping (if justified) and application of fluoride varnish/chlorhexidien varnish.

FOTI and transilumination method can be helpful while making a decision about invasive treatment of interproximal caries, particularly in situation, where radiographs are not available, eg. special needs patient and/or general anaesthesia session.

So-called “mini dam” can be helpful for moisture control during eg. fissures sealants in children.

Blood pressure monitor use for any situation in which thers is a suspicion about increased blood pressure

Simple thermometer to check body temperature if any dental infection. Can be very useful to make and justify a decision about antibiotic prescription in case of spreading infection. Ideally contact less, measuring the forehead temperature from distance

Temperature measurement can be a nice ,distracting’ action while dealing with the autistic patient or child

Thermal camera – a non-invasive diagnostic measure to detect a potential source of odontogenic infection in uncooperative patients with eg. severe learning disability

Periofilm- an adhesive dressing to protect eg.  the post-xla socket